On the CUSP: Stop CAUTI Cohort 4

1. On the CUSP: Stop CAUTI Cohort 4 Mapping the Journey Hospital Unit Team Project Orientation Webinar April 12, 2012

2. Your Feedback is Important! https://www.surveymonkey.com/s/CAUTICallEvaluation

3. Agenda

4. Project Goals The Project Goals for On the CUSP: Stop CAUTI are to: Reduce mean CAUTI rates in participating clinical units by 25 percent; and Improve safety culture as evidenced by improved teamwork and communication by employing CUSP methodology.

5. Learning the Language CAUTI – Catheter Associated Urinary Tract Infection CUSP – Comprehensive Unit Safety Program AHRQ – Agency for Healthcare Research and Quality HSOPS – Hospital Survey on Patient Safety Culture NHSN – National Healthcare Safety Network CDC HICPAC – Center for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee

6. Learning the Language • Cohort • Learning session • Content call • Coaching call • Process measures • Outcome measures

7. Learning the Players AHA – American Hospital Association HRET – Health Research and Educational Trust MHA – Michigan Health and Hospitals Association, Keystone Patient Safety Center U of M – University of Michigan St John – St. John Hospital and Medical Center JHU – Johns Hopkins University, Armstrong Institute for Patient Safety and Quality APIC – Association for Professionals in Infection Control and Epidemiology, Inc. SHEA– Society for Healthcare Epidemiology of America SHM– Society of Hospital Medicine 

8. CAUTI National Project Team HRET MHA UM/St. Johns JHU State Hospital Associations, Partners & Coalitions Extended Faculty State Leads, QIO, HEN- Coaching/CUSP/ Recruitment/Project Liaison National & Regional CAUTI Faculty APIC, SHEA, SHM Coaching/Recruitment/ Endorsement Partnerships & Dissemination Hospitals/Units

9. Project Vitals Original Contract - Aug 2010 – 2011 Expansion Awarded - Aug 15, 2011 • Base year + 3 option years Duration 18 months Components - Technical and Adaptive All units

10. First 3 Cohorts, 19 States, 441 Hospitals

11. Registered Unit Types

12. Cohort 4 - Vitals Start date May 2012 End date October 2013 Duration 18 months

13. Deliverables Educational events: Teleconferences, webinars, in-person meetings (with video conferencing) Materials: Implementation guide with tools (guidelines, posters, forms, educational materials) Coaching: National and regional supported calls Data: On-line secure collection and reporting Site visits: Selected sites within selected states

14. Cohort 4 Timeline

15. Next Steps Recruitment of hospitals: March 6, 2012-May 3, 2012 Teams, registration, Data Use Explanation (DUEs) Learning Session #1 – May 3, 2012 On-boarding calls – Begins two weeks after Learning Session #1

16. CUSP - CAUTI Goals: Required Data GOAL #1 Improving the Culture of Safety: CUSP Required Data STEPS: 1. Educate on the science of safety 2. Senior Executive Adopts Unit 3. Identify Safety Defects 4. Learn from Defects 5. Use teamwork/ communication tools Quarterly Team Checkup Tool (TCT) HSOPS at baseline and post-intervention

17. CUSP - CAUTI Goals: Required Data GOAL #2 Reduce CAUTI’s by 25% Required Data STEPS: 1. Educate staff about impact of CAUTI’s 2. Educate staff about appropriate indications for a catheter 3. Daily Catheter Rounds 4. Proper Insertion Technique 5. Proper Maintenance Technique Process Measures (Prevalence and appropriateness) Outcome Measures (CAUTI Rates – using NHSN definition)

18. Data Collection Processes Each Cohort has a specific data collection schedule (timing differs by Cohort) Data is collected through MHA Care Counts, NHSN and online surveys Process data is defined by CDC HICPAC Guidelines Outcome data is defined by CDC NHSN Definitions

19. Data Collection Prevalence & Appropriateness (Process)- How often do we do what we should? • Assess each patient on the unit for the presence of a urinary catheter • Record the reason for the catheter CAUTI Rates (Outcome)-Did we make a difference? • Number of Symptomatic CAUTI’s attributable to your unit for that month • Number of urinary catheter days per month (number of patients with urinary catheter device is collected daily at the same time each day and the total is summed for the month) • Number of patient days per month Team Checkup Tool (Culture) Quarterly Hospital Survey on Patient Safety (Culture) Baseline and Follow-up Readiness Assessment (Once)

20. Cohort 4: Data Collection Schedule

21. Cohort 4: Data Collection Schedule

22. Cohort 4: Data Collection Schedule

23. Unit Team’s Goal Develop and or expand capacity at the hospital unit level to support improvement by: • CUSP content expertise • CAUTI prevention expertise Reduce CAUTI and Improve Safety

24. Hospital Project Unit Team Leader Tasks Review Implementation Manual Develop a unit based (frontline care provider) team Attend /participate in educational and coaching opportunities Schedule regular meetings Involve all team members in team tasks Communicate to all team members Communicate with Sr executive Assure data is collected and submitted Assure team is meeting project milestones

25. Hospital Unit Team Tasks Attend and participate in unit team meetings Provide frontline care providers perspective Implement 5 steps of CUSP program Share in responsibility of team’s work • Participate in design of processes to support prevention of CAUTI • Educate of staff, physicians, others • Communication to others on the unit • Champion effort • Data collection and submission

26. Unit Team: A Success Story STOP CAUTI TEAM Liberty Hospital Liberty, Missouri Team Members: Margaret Stuck, RN, Clinical Resource Leader, 3E Suzie Heath RN, Clinical Resource Leader, 4S Amy Swartz RN, Clinical Resource Leader, 3S Jo Micek RN, Infection Preventionist Raghu Adiga, MD, LH Medical Epidemiologist David Feess, CEO, President, Liberty Hospital

27. Hospital Information A Public non profit hospital that has 250 licensed beds and more than 1,900 employees that serve Clay and Platte Counties, as well as northwest Missouri.

28. Why we Joined the NationalOn the CUSP Collaborative Missouri Hospital Association provided an opportunity to participate in the CUSP based methodology for prevention of Urinary Tract Infections. Liberty Hospital had been working on prevention of CAUTIs but had not met our goals on all participating units. Non-reimbursement for CAUTIs, patient safety and decreasing inappropriate use of devices were identified as drivers for participation.

29. Our Journey Senior Executive supported resource time to participate. Team leader for each unit Data entry resources Resources to attend KICK OFF Meeting Team meetings Pre CUSP work Unit needs to have structure in place for daily nursing rounds. KICK OFF Meeting- to begin to understand the collaborative efforts and results.

30. Our Journey Base Line Data Collection identified defects in our process: Appropriate indication for placement of catheter • Sacred Cows • Misinformation on S.C.I.P. indications • Push back from physicians regarding acceptable indications Care of the catheter Removal of catheter Challenges in device day collection with new computer documentation

31. SACRED COWS “ The physician knows they have a catheter and will let us know when to remove it.” “If the patient is incontinent they need a catheter.” “If they are an orthopedic patient; they need a catheter.” “If they come from a nursing home they need a catheter.” “The patient requested it.”

32. Our Journey Base Line Data Collection identified defects in our process: Appropriate indication for placement of catheter • Sacred Cows • Misinformation on S.C.I.P. indications • Push back from physicians regarding acceptable indications Education needs on Care of the catheter Education needs on Removal of catheter Challenges in device day collection with new computer documentation

33. Our Journey IMPLEMENTATION: Standardize: Device documentation Education on approved indications for foley use Expectation of Indwelling Foley Care Develop Algorithm for assessment, placement and removal of indwelling urinary catheters. Utilize “Annual Competency Lab” to market - Correct Catheter Care

34. Our JourneyImplementation Correct Catheter Care • Identified a mascot! • Posters • Flyers • Skills Lab • Foley Kit Vendor • Outpatient services for Incontinence

35. Our JourneyResults

36. Our Journey Results

37. Our Journey Results

38. Lessons Learned Valuable investment of time to attend Kick- Off meetings. CAUTI calls were valuable to stimulate discussion and ideas during Team Meetings. Schedule meeting time to develop projects. Brainstorm freely and with possibility. Communicate successes! Communicate and work with physicians, transporters, support staff who also touch the catheter. Commitment from Team Leaders and Administration

39. Our Journey & Next Steps • Nurse Driven Foley Removal Protocol implementation (just approved!) • Updated indications in our e HR • CAUTI Learning from a Defect lite tool development

40. Questions?

41. Contact Information For future questions, contact:

42. Your Feedback is Important! https://www.surveymonkey.com/s/CAUTICallEvaluation